Fatal Hypermagnesemia Caused by an Epsom Salt Enema: A Case Illustration

Nancy M. Tofil, MD; Kim W. Benner, PHARMD; Margaret K. Winkler, MD

Disclosures

South Med J. 2005;98(2):253-256. 

In This Article

Abstract and Introduction

The authors describe a case of fatal hypermagnesemia caused by an Epsom salt enema. A 7-year-old male presented with cardiac arrest and was found to have a serum magnesium level of 41.2 mg/dL (33.9 mEq/L) after having received an Epsom salt enema earlier that day. The medical history of Epsom salt, the common causes and symptoms of hypermagnesemia, and the treatment of hypermagnesemia are reviewed. The easy availability of magnesium, the subtle initial symptoms of hypermagnesemia, and the need for education about the toxicity of magnesium should be of interest to physicians.

Hypermagnesemia can be fatal, especially if a delay in recognition occurs. Initial symptoms of hypermagnesemia, such as nausea, vomiting, and weakness, are nonspecific and can progress rapidly to respiratory depression, hypotension, cardiac arrest, and death. Treatment is directed toward reversing the toxic effects of magnesium, primarily in the cardiovascular and nervous systems, discontinuing any further magnesium administration, and diuresis to aid in the elimination of excess magnesium. Hypermagnesemia is most commonly seen in patients with renal insufficiency; however, it can also be seen in individuals with normal renal function, if enough magnesium is administered orally, intravenously, or rectally.[1,2] Therefore, to stress the importance of early recognition and prevention of accidental magnesium toxicity, we present a patient with fatal hypermagnesemia from an Epsom salt enema. The Institutional Review Board at the University of Alabama at Birmingham reviewed and approved publication of this case report.

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